COVID-19 in Children and Neonates: A Comprehensive Review Article

Abstract

Context: Novel coronavirus (COVID-19) has become a new public health crisis, posing a great threat to the people all around the world. We aimed to review the articles on COVID-19 in pediatric population to help physicians and other healthcare workers understand the importance of detecting silent disease carriers in this age group and stop further transmission to other healthy individuals and manage symptomatic patients based on the latest recommendations. Methods: We searched databases including PubMed, Scopus, Google Scholar, and Medline and reviewed 70 articles from December 2019 to mid-July 2020. Relevant articles about COVID-19 in children were included. Results: According to the latest reports, 1% - 5% of infected patients were under 19 years old. Death in this age group was rare but it can occur in children with severe disease. The overall course of disease -mainly pulmonary involvement- of the infected children tend to be milder than adults. This may be related to both host factors and exposure. The lab tests and computed tomography (CT) scan findings are nonspecific and milder compared to those in older ages. The cornerstone of COVID-19 management in pediatric group is supportive care. Of note, there is not any approved specific drug for treatment of children affected by COVID-19. Conclusions: COVID-19 disease characteristics in children are not yet fully established, which poses a significant problem for pediatric medical specialists. It should be considered that most children are asymptomatic or have mild symptoms. Critical cases, although uncommon, can occur especially in children with underlying diseases.

COVID-19 Mortality in Children: A Referral Center Experience from Iran (Mofid Children’s Hospital, Tehran, Iran)

“…There is a risk of infection and mortality in all age groups of children with COVID-19 infection [ 19 ]. From studies of Olivia et al in the United Kingdom, Philip et al in New York City, and the CDC, the severity and mortality of COVID-19 were higher in children under age 1 and adolescents [ 20 – 22 ].…”

Detection of SARS-CoV-2 antibodies in pediatric patients: An Iranian referral hospital-based study

“…The possible mechanisms might be due to the differences in Angiotensin -converting enzyme 2 (ACE2) expression, innate immunity, and the influence of preventive strategies including closure of schools and day-care centers [20]. However, increased availability of PCR tests even for milder cases has played a great role in patient detection [1]. Li et al suggested that 86% of all early COVID-19 infections in China remained undiagnosed, while undocumented cases may have a lower transmission rate, their extensive number indicates that they could have been the origin of 79% of all early cases.…”

“…The novel coronavirus (COVID- 19) outbreak has evolved into a novel public health disaster, which the World Health Organization (WHO) has classified as a pandemic since March 11, 2020 [1]. However, the actual infection rates are probably similar to those of adults, even if the actual prevalence in children is difficult to quantify due to different symptoms, lack of consideration or less severe course of the disease [2,3].…”

The youngest surviving COVID-19 patient: A case report

“…Our case along with some other reported cases from all around the world [9] , [10] , [11] , [12] , seem to further support this route of transmission. Children and specially neonates with COVID-19 are mostly asymptomatic or develop mild symptoms for which supportive care usually suffices [13] , [14] , [15] . To date, our case seems to be the youngest survived patient among the very few neonatal cases who have received antiviral therapy (remdesivir), IVIG and corticosteroids due to respiratory failure and the critically unstable status resulting from COVID-19 [6] , [14] , [16] , [17] , [18] , [19] .…”